ICU内从机械通气患者的牙菌斑与支气管肺泡灌洗液中分离的呼吸道病原体间的基因型关系

David

Clinical Infectious Diseases 2008;47:1562–1570 © 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4712-0011$15.00
DOI: 10.1086/593193

MAJOR ARTICLE
Genetic Relationships between Respiratory Pathogens Isolated from Dental Plaque and Bronchoalveolar Lavage Fluid from Patients in the Intensive Care Unit Undergoing Mechanical VentilationICU内从机械通气后患者的牙菌斑与支气管肺泡灌洗液中分离出的呼吸道病原体之间的基因型关系
Seok-Mo Heo,1
Elaine M. Haase,1
Alan J. Lesse,2,3,5
Steven R. Gill,3,4 and
Frank A. Scannapieco1
Departments of 1Oral Biology, 2Pharmacology and Toxicology, 3Microbiology and Immunology, and 4Center for Excellence in Bioinformatics and Life Sciences, University at Buffalo, The State University of New York, and the 5Veterans Administration Western New York Healthcare Center, Buffalo

Background.  Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in patients hospitalized in intensive care units. Recent studies suggest that dental plaque biofilms serve as a reservoir for respiratory pathogens. The goal of this study was to determine the genetic relationship between strains of respiratory pathogens first isolated from the oral cavity and later isolated from bronchoalveolar lavage fluid from the same patient undergoing mechanical ventilation with suspected VAP.


Methods.  Plaque and tracheal secretion samples were obtained on the day of hospital admission and every other day thereafter until discharge from the intensive care unit from 100 patients who underwent mechanical ventilation. Bronchoalveolar lavage was performed for 30 patients with suspected VAP. Pulse-field gel electrophoresis and multilocus sequence typing were used to determine the genetic relatedness of strains obtained from oral, tracheal, and bronchoalveolar lavage samples.


Results.  Isolates of Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter species, and enteric species recovered from plaque from most patients were indistinguishable from isolates recovered from bronchoalveolar lavage fluid (i.e., had >95% similarity of pulse-field gel electrophoresis patterns). Nearly one-half of the Pseudomonas strains showed identical genetic profiles between patients, which suggested a common environmental source of infection.


Conclusions.  Respiratory pathogens isolated from the lung are often genetically indistinguishable from strains of the same species isolated from the oral cavity in patients who receive mechanical ventilation who are admitted to the hospital from the community. Thus, dental plaque serves as an important reservoir for respiratory pathogens in patients who undergo mechanical ventilation.



Trial registration.  ClinicalTrials.gov identifier: NCT00123123


Received 14 May 2008; accepted 25 August 2008; electronically published 7 November 2008.